Implementation science theories, models, and frameworks provide structure and guidance when translating evidence into practice and policy. The Knowledge-to-Action (KTA) Framework, published by Graham and colleagues in 2006, is among the most highly cited frameworks for guiding implementation efforts. However, after nearly 20 years of use, little is known about how the KTA Framework has been applied over time or whether more recent implementation science priorities, such as application of multiple theories, models, and frameworks, knowledge user engagement, and equity considerations are reflected in its use. The purpose of this citation analysis and scoping review was to explore how the KTA Framework has been used as reported in the published literature. We conducted a citation analysis and scoping review following the JBI Scoping Review Methodology. Papers were eligible if they cited one of two core KTA Framework references. Forward citation searches were conducted in Scopus, Web of Science, and Google Scholar on April 16, 2024. We categorized included papers, based on application of the framework, into three use levels: referenced (citation only), conceptual (informing or guiding the approach), and instrumental (guiding implementation activities). An independent reviewer extracted data from conceptual and instrumental papers and all extracted data were verified by a second reviewer. We analyzed data using descriptive statistics and qualitative content analysis. Of 8,671 sources retrieved, 4,208 underwent full-text screening; 3,258 referenced the KTA Framework only, and 825 used it conceptually (n = 438) or instrumentally (n = 387). Citation and use of the KTA framework has increased steadily over time, growing from 1787 citations by 2013 to 4285 citations by April 2024. The largest number of included papers were from Canada (n = 405, 49.1
Adaptation has emerged as a critical area within implementation science and practice, reflecting the need to modify interventions and strategies to better fit specific contexts and improve implementation outcomes, while also maintaining fidelity. This methodology paper proposes the Adaptation with Equity (AwE) framework as a principled and process-driven framework for creating equity-focused adaptation guidance for interventions or implementation strategies. It offers implementers, researchers, and organisations a process to co-create adaptation guidance. It is a process framework involving eight sequential but overlapping steps: partner with organisations serving equity-deserving groups, prepare, establish Adaptation Teams, run Adaptation Team workshops, analyse suggested adaptations, and develop adaptation guidance. Once adaptation guidance is produced it can be field tested and revised alongside the intervention or implementation strategy. We present the detailed methods and procedures we developed to operationalise each of these steps in a project to produce an Adaptation Guide for the Walk the Talk toolkit – an implementation strategy for implementing guidelines for recovery-oriented practice. Future research should test AwE for other implementation strategies as well as interventions, guidelines and knowledge mobilisation products, in a range of settings.
External facilitation (EF) is a key measure for strengthening the implementation of complex interventions. However, limited evidence exists on how EF works across different contexts. This study aims to explain how, why, under what circumstances, and for whom EF supports the implementation of complex interventions in healthcare settings. An initial theory of EF was developed by a monitoring committee comprising researchers, research staff, clinicians, and patient partners, using a participatory and iterative realist synthesis approach. This initial theory, comprising constructs from existing theories and frameworks in implementation science, guided the collection and analysis of data from empirical studies identified through a previous scoping review on the role of external facilitators in the implementation of complex healthcare interventions. Additional sources on these complex interventions were also included. The data (primary studies and additional sources) were coded to identify context-mechanism-outcome configurations, informing the refinement and development of the EF theory. The review included 36 primary studies examining EF in the implementation of 34 complex interventions, as well as 105 additional sources. The analyses identified 14 context-mechanism-outcome configurations grouped into four demi-regularities: sensemaking and coherence-building; capacity-building and self-efficacy; development and maintenance of good relationships; and engagement and ownership. The refined theory of EF highlighted new mechanisms such as sensemaking, coherence-building, team cohesion, and external facilitators’ capacity to transform implementation barriers into opportunities. The findings provide guidance for optimizing EF in the implementation of complex interventions. The next phase will test and refine the theory through a realist evaluation.
Cancer mortality rates have consistently declined in the United States (US) in recent years, largely due to the implementation of evidence-based practices (EBPs) in prevention and early detection. However, the implementation of these practices has been slow, often taking over a decade to reach half of the eligible population. This study examined the national trends in time to implementation of four cancer-related EBPs across different US population subgroups and explored possible factors driving differences. The National Cancer Institute’s Cancer Trends Progress Report (2022) and the National Health Interview Survey (NHIS) (2000–2018) provided data for this study. EBPs evaluated included: clinicians’ advice to quit smoking, colorectal cancer (CRC) screening, mammography screening and HPV vaccination. Time to implementation was conceptualized as the number of years between the publication of the first EBPs’ guidelines and their uptake by at least 50
The science of deimplementation—reducing harmful or ineffective practices—has focused almost exclusively on clinical prescribing, with no studies conducted in community or educational settings. Early care and education (ECE) settings offer a strategic venue for shaping eating behaviors, with children consuming up to 500 meals annually in these environments. However, ECE educators routinely use feeding practices that undermine self-regulation, including pressuring children to eat, rushing mealtimes, and offering food as reward. These practices contribute to food aversions, diminished self-regulation, and obesity risk. We will conduct a Hybrid Type 3 cluster-randomized trial evaluating a co-designed deimplementation strategy package (WISE Words) across 88 ECE sites in Arkansas and Louisiana. Sites will be randomized 1:1 to WISE Words or usual practice, with usual practice sites receiving the intervention after two years (waitlist design). WISE Words includes six strategies: dynamic training using improvisation methods, peer learning collaboratives with goal setting, external facilitation, audit and feedback, environmental reminders, and tailored educational materials. The primary outcome is de-adoption of inappropriate feeding practices measured via direct mealtime observation (Table Talk). Secondary outcomes include adoption of evidence-based practices, acceptability, appropriateness, and sustainability at 12- and 24-months post-intervention. Child outcomes include Body Mass Index, skin carotenoid levels (Veggie Meter) willingness to try new foods (observed) and food neophobia (teacher and caregiver report). An explanatory sequential mixed methods design will test mechanisms of change derived from the Implementation Trust Building Theory of Change examining whether trust mediates strategy effects on outcomes. This trial extends deimplementation science into community settings by targeting culturally embedded behavioral practices rather than clinical prescribing behaviors. Results will inform approaches to shifting entrenched practices in ECE and similar settings while testing trust as a deimplementation mechanism. Sustainability assessments will address a notable gap, as few studies have examined whether deimplementation effects persist. NCT07101321, July 20, 2025.
